title: Ultrasound-guided infraclavicular brachial plexus block enhances postoperative blood flow in arteriovenous fistulas.
abstract: OBJECTIVE
  Brachial plexus block offers several advantages when creating vascular access for hemodialysis. However, no controlled studies have directly evaluated arteriovenous fistula (AVF) blood flow in patients anesthetized by this method. We compared the effects of ultrasound-guided, infraclavicular brachial plexus block and local infiltration anesthesia on blood flow in the radial artery and AVF during the early and late postoperative periods.
  
  
  METHODS
  Sixty patients were randomly assigned to an experimental group, which received infraclavicular brachial plexus block (IB), or to a control (C) group that received local infiltration anesthesia. Blood flow in the distal radial artery was measured before and after IB or infiltration anesthesia. AVF flow during the early and late postoperative period was evaluated using duplex ultrasound imaging. The rates of primary fistula failure were also compared.
  
  
  RESULTS
  After anesthesia, preoperative radial arterial flow was 56 ± 8.6 mL/min in group IB vs 40.7 ± 6.11 mL/min in group C (P < .0001). Blood flow in the fistula, measured in mL/min at 3 hours, 7 days, and 8 weeks postoperatively, was also greater in group 1B vs group C, respectively, at 69.6 ± 7.9 vs 44.8 ± 13.8 (P < .001), 210.6 ± 30.9 vs 129 ± 36.1 (P < .001), and 680.6 ± 96.7 vs 405.3 ± 76.2 (P < 0.001).
  
  
  CONCLUSIONS
  When used for AVF access surgery, infraclavicular brachial plexus block provides higher blood flow in the radial artery and AVF than is achieved with infiltration anesthesia.
authors.affiliation: Department of Anesthesiology, Gaziantep University, Faculty of Medicine, Gaziantep, Turkey. drlsahin@hotmail.com
authors.forename: Levent
authors.initials: L
authors.lastname: Sahin
authors.forename: Rauf
authors.initials: R
authors.lastname: Gul
authors.forename: Ayse
authors.initials: A
authors.lastname: Mizrak
authors.forename: Hayati
authors.initials: H
authors.lastname: Deniz
authors.forename: Mehrican
authors.initials: M
authors.lastname: Sahin
authors.forename: Senem
authors.initials: S
authors.lastname: Koruk
authors.forename: Mehmet
authors.initials: M
authors.lastname: Cesur
authors.forename: Sıtkı
authors.initials: S
authors.lastname: Goksu
mesh_terms: D000328:Adult; D000772:Anesthesia, Local / Q000009:adverse effects; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001340:Autonomic Nerve Block; D001783:Blood Flow Velocity; D001917:Brachial Plexus / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012039:Regional Blood Flow; D006435:Renal Dialysis; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey; D018616:Ultrasonography, Doppler, Duplex; D018084:Ultrasonography, Interventional; D014654:Vascular Patency